Prof. Jean-Francois Etter Interview: Long-Term Vaping is Not a Public Health Problem

A new study looking at the long-term behavior of vapers was published in Addictive Behaviorslast month, surveying users on both their vaping and smoking habits to provide insight into how vapers change over a 12-month period.

The research comes from Prof. Jean-Françios Etter (Professor of Public Health at the University of Geneva) and Dr. Chris Bullen (Clinical Trials Research Unit, University of Auckland), and you can read a detailed summary here. We caught up with lead author Professor Jean-Françios Etter for a short interview about the study, its findings and the wider implications of the research.

What would you say was the most important finding of your study?

JFE: This is one of the very first studies of vapers with 12 months follow-up. We found that very few ex-smokers relapsed to smoking, and that many smokers (i.e. dual users) either reduced or quit smoking after 12 months.

You acknowledge in the paper that the recruitment methods used may have led to an unrepresentative sample, do you think their increased motivation to quit smoking as a group impacts on the weight of the findings?

JFE: Yes, it is quite possible, these results should be considered as exploratory, and preliminary. Studies in representative samples of vapers are warranted. But because this is one of the very first studies of this type, the results are valuable, and encouraging.

Do you think vapers in general are inclined to exaggerate the benefits of e-cigs in surveys like this?

JFE: It is not impossible, in particular because many participants were recruited on e-cig forums, where many participants are pro-e-cig activists. But my experience with surveys suggests that most people are honest.

Your findings show that dedicated vapers don't really decrease their consumption over time – would you say that this shows that e-cigarettes merely prolong addiction, as many anti-smoking groups allege?

JFE: Our data (and other studies) suggest that e-cigs are not very addictive, much less addictive than tobacco cigs. The conventional definition of addiction has two components (compulsive use in spite of harm). Because e-cigs do not cause harm, it is more appropriate to talk about compulsive use rather than of addiction in the case of e-cigs. There are thousands of ex-smokers who use the nicotine gum compulsively, several months or years after quitting smoking, and this is not a public health problem either.

If further studies confirmed that most vapers continue to vape for extended periods of time, would this mean e-cigs are ineffective for their intended purpose? What would the consequences be for future safety research?

JFE: Even if there are long-term vapers, this is not a problem, as long as they quit smoking. The problem is combusted tobacco, not nicotine. At the dosage used by vapers or users of nicotine gums or patches, nicotine is not toxic. Long term vaping is not a public health problem; not any more than long term use of nicotine gums.

From your sample, it appears that dual users are actually fairly likely to quit smoking within a year – do you think the concern from anti-smoking groups about the potential risks of dual use is justified?

JFE: Dual use seems to have two consequences: reduced smoking, and eventual smoking cessation (in about half the dual users after one year in our data). This suggests that dual use should be considered positively.

No ex-smokers in your study who were vaping relapsed to daily smoking – why do you think the relapse rate is so low? Do e-cigs really seem to be that effective, or is it likely to be just a quirk of the sample selection process?

JFE: Both elements played a role here, But the effect is so large (normally 95% of ex-smokers relapse within one year) that it cannot be attributed only to selection problems, there must be a real effect here. E-cigs most probably prevent relapse in former smokers.

Is there any aspect of the behavior of vapers which you think particularly warrants further investigation?

JFE: Yes, their behavior change over time is almost undocumented; many hypotheses need to be tested (whether they switch from cig-a-likes to tank systems over time, whether they change nicotine concentrations in liquids over time, e.t.c.). Many questions remain unanswered.

We’d like to thank Professor Etter again for his time – and hope to see more interesting research like this in future! He has another long-term survey in the pipelines, which hopes to offer further insight into vapers’ long-term behavior, but it’s currently in need of more participants. If you’re over 18 and have vaped before, you can participate in the research by following this link!